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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/18/18 <br />Name Sue Ellen Doudrick <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 12/20/18 Phone Extension 5922 <br />�Mwr�w <br />Re uired Prior to Submittal to Board <br />Legal [ Attorney Name: Clara McDaniels <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />LJ Agreement Amendment <br />El Professional Services <br />Bid Opening <br />El Quote Opening <br />Change Order No. <br />El Ease/Encroach. <br />F Other: <br />Michael Schmidt <br />iropriatewwItwem Type — Re <br />El Contract <br />❑ Resolution <br />® Bid Award <br />Quote Award <br />El C/O & PCA No. <br />0 Traffic Control: <br />d for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />Required Information <br />............................._ <br />❑ PCA <br />Addendum <br />® Title Sheet <br />Company or Vendor Name Selge Construction <br />Yes Z No <br />If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor MBE F WBE <br />MBE/WBE Contractor Requested ❑ No ❑mYesmmm Name of Company <br />m <br />Project Name Small Drainage Design and Repair <br />Project Number 118-063 <br />g —.... Utility o Service Fund <br />Funding Source Utilit Ex ense/Contractual mm .........� ......_.. ...�� �. <br />Account No. 251.0608.431.42.96 (LRSA) for Olivia Circle Division Bw_ <br />Amount $104,768.28 <br />..-------- <br />.....................................--..._.._.._....—............ <br />........ <br />................. <br />.......�..... __ �.�........... �.�......... <br />Terms of Contract Unit prices <br />Drainage Improvements to 1) Olivia Circle 2) Creekwood <br />sHawbaker Street Purpose/Description escription � Estates 3 ........................m.......wn..,,, _ - mm�,,,,..������..._.....��__................................��......................................m��_ <br />" Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />�u�%�re For Chan a Orders Onl ... m....m� .... . . Vie.. ..._ <br />Amount of ❑ Increase $ <br />El Decrease $ <br />